Wednesday, March 26, 2008

The hospital is not a hotel

Here is an argument by Dr. Robert Wachter that having a set discharge time for patients is counter-productive (here). From a practical stand-point hospitals push to get any pateints they can out by 11am (at least discharge orders written) so they know how many beds are available. In reality, discharges happen all day long and the push for 11am can be a major pain.

Dr. Wachter discusses the implications to staff and approaches it from a classic queue theory standpoint. Even though I experience the same thing, I never really stopped to think about it. From a lean process point of view, one would think, that it's the difference between batch processing (which is inefficient and needs greater resources) and one-piece work flow (one-patient in, one-patient out). I think hospitals may actually be costing themselves money by using the 11am model.


NurseDan said...

No crack here, just poking the lion. gotta get some brainstorms out there to keep my mind working. i think we can at least pull some concepts from other industries into healthcare, in fact, i think we have to.. I really like your posts by the way. I enjoy your thoughts on waits. As an ED nurse I am honded by them at all times.

Anonymous said...

It's about time someone said it....these policies always seemed arbitrary and ineffective. By definition they encourage batching which is counter to establishing good flow. Not to mention, it only serves to irritate practitioners by posting signs up everywhere. Good post